复发性结直肠癌的临床病理特征和预后

目的探讨复发性结直肠癌的临床病理特征和预后。方法对进行根治性切除的993例结直肠癌患者中235例复发患者的临床资料进行总结，并分析术后复发的影响因素。结果根治术后全组总体5、10年生存率分别为67．7％和55．8％；术后复发组则分别为43．9％和28．1％；差异有统计学意义（P〈0．001）。复发组患者中，再次行根治性切除者的5、10年生存率分别为50．2％和32．7％；而予以姑息手术或保守治疗者则分别为25．8％和0；差异亦有统计学意义（P〈0．001）。单因素分析显示，复发的结直肠癌患者年龄、癌性肠梗阻和腹水、淋巴结转移及肿瘤大体分型、侵袭程度及病理分期与术后复发密切相关；而多因素分析则显示，癌性肠梗阻和腹水、肿瘤大体分型及病理分期与术后复发和转移密切相关。结论根治术后结直肠癌患者的复发和转移与癌性肠梗阻和腹水及肿瘤病理分期密切相关；再次手术切除可以提高复发转移患者的生存率。

Clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer

Objective To investigate the clinicopathological characteristics and prognosis of patients with recurrent coloreetal cancer.Methods Clinicopathological characteristics and postoperative survival of 235 patients with recurrent eolorectal cancer after radical resection were retrospectively analyzed,and was compared with that of 993 patients with radieal resection.Results The overall 5- and 10-year survival rates after radical resection were 67.7% and 55.8%,respectively.The 5- and 10-year survival rates in patients with recurrent colorectal cancer was 43.9% and 28.1% (P=0.000),respectively.Among patients with recurrent colorectal cancer,the 5- and 10-year survival rates of the patients underwent second radical resection were 50.2% and 32.7%,while the 5- and 10-year survival rates of the patients without second surgery were 25.8% and 0,respectively(P=0.000).On univariate analysis,postoperative recurrence was associated with age at diagnosis,cancerous ileus,ascites,lymphy nodes involvement,gross types,infdtration of tumor and Duke's stage.Multivariate analysis revealed that cancerous ihus,ascites,gross types and Duke's stage were independent predictive factors for postoperative recurrence.Conduston Cancerous ileus, ascites,gross types and Duke's stage were independent predictive factors for recurrence and metastasis of colorectal cancer after radical resection.The 5- and 10-year survival rates and qulity of life could be improved by second radical resection.